Six months of South African TB activism

Whenever a major HIV and TB conference takes
place in South Africa, one has come to expect a significant activist presence —
and at least under the current minister of health — engagement. With groups
like the Treatment Action Campaign (TAC) — arguably the most renowned treatment
activist organization since ACT UP New York — and its natural allies, Médecins
sans Frontières (MSF) and Section 27 (the legal wonks formerly known as the
AIDS Law Project), activism and campaigns are sometimes as much on show as the
clinical science — and often far more impactful.

After all, the very first global march for TB
education, prevention, treatment and cure was held at an international TB
conference (the Union’s) in Cape Town, in November 2007. The focus this year is
likely to be more domestic — but what happens in HIV and TB in South Africa is
of global significance.

In fact, over the past several months, in the
run-up to the 3rd South African TB conference being held this week in Durban,
South Africa, activists have been busy tackling several issues that could be
critical to more effective TB control in the country.

Revising
South Africa’s patent law/intellectual property (IP) policies
— which at present are part of the reason why the country is paying far more
than it should for many medications, including exorbitant prices for
second-line TB treatment (ZAR 24,000 per course) as well as cancer drugs and
other essential medications. The activists argue that the country’s patent law
should be adapted to take advantage of the flexibility built into international
trade law that allows countries to take “measures to protect public health... and…
promote access to medicine for all.”

Multiple partners within the South African government have been working
together to review the country’s intellectual property policy, while the
portfolio committee on trade and industry in parliament has also been reviewing
intellectual property across the board to put together an intellectual property
policy. Unfortunately, the process has been less than transparent; reports are mixed
on what sort of policy is being developed — and there are indications that the
US government has been trying to influence the process in favour of maintaining
strong protections for intellectual property.

During an interview with HATIP, Mara
Kardas-Nelson of MSF noted that the country’s internal policies are
inconsistent with the positions it takes on the global stage. “South Africa,
internationally, keeps saying things like developing countries need [to be]
supporting TRIPS flexibilities and local production and access to medicines in
order to adequately address health needs,” she said. “At the World Intellectual
Property Organisation (WIPO), they’ve actually led the African Group and
Development Group in putting together a position asking for clarification from
WIPO on the impact of using TRIPS flexibilities, and practical implementation
advice for countries hoping to implement TRIPS flexibilities. So the country does all of these great things
on the international stage—then on the national stage, the exact opposite is
happening, where policy makers in the country really push back against advocacy
to implement TRIPS flexibilities.”

Why the South African government
would choose to limit its options to import or produce affordable essential
medications given the public health needs faced by the country — and the
government’s constitutional obligation to provide access to health care
services — is unclear. However, there is a tendency among some smaller resource-
constrained countries in the region to voluntarily go along with US and EU
efforts to adopt stronger IP protections than required by international trade
agreements. “It’s like there’s this notion of needing to be pro-IP in order for
development basically,” Kardas-Nelson told HATIP.

The activists have launched the “Fix
the Patent Laws” campaign to increase awareness of the issue and encourage the
South African government to stand up for its rights — just as Brazil, India and
China (its partners in BRICS) have done. To support the campaign, TAC and MSF
have held day-long training events for the media. TAC, represented by Section
27, has become involved in a patent dispute
over a generic cancer drug, asking the South African Supreme Court to consider
the constitutional right to access to health care services in its decision.
They have also published a briefing document
online explaining the different legal flexibilities available to South Africa
that could be used to reduce costs and increase access to lifesaving
medications. There is also a blog for the campaign
at http://www.fixthepatentlaws.org/.

Prisons: Activists are also demanding that the South
African government remedy the horrendous living conditions, non-existent infection
control, poor access to timely diagnosis and treatment that have turned South
Africa’s prisons into engines for TB transmission. Not only is such negligence
and injury to prisoners’ health a violation of the South African Constitution
and prisoner’s human rights, it is bad public health policy as these often
undiagnosed and untreated individuals could unwittingly spread the infection
once back in their communities.

Details of just how bad conditions were in one
South African corrections facility, Pollsmoor Prison Complex, came to light
after a court judgement against the facility in favour of a man who probably
contracted TB while awaiting trial in jail (for a period of almost five years).
Subsequently, a mathematical model published in the South African Medical
Journal calculated the risk of TB transmission in the facility to be 90% in one
year.

Xpert MTB/Rif access: Activists are challenging Cepheid, the manufacturer
of the Xpert MTB/Rif test (and the GeneXpert equipment it is performed on) to
reduce the price of the test from the current $17 per cartridge (test) down to $7
per cartridge; and for the government and National Health Laboratory Services
to take steps to reduce the other costs associated with importing and
implementing the test.

An open letter to Cepheid stating the activist demands can be found here.
Midway through the conference UNITAID announced a financing deal that will
bring the price per cartridge down to $10. More on that later.

Compassionate access to bedaquiline: Advocates are pressing the
South African Medicines Control Council and Ministry of Health to expedite compassionate use access in South Africa for bedaquiline
(TMC207), one of the new experimental TB drugs which is furthest along in
clinical development, for people with extensively drug-resistant TB (XDR-TB)
and pre-XDR-TB. Bedaquiline — a potent anti-TB drug that people with drug
resistant TB should be fully susceptible to since it comes from a novel class of
drugs — may be the only way to save a person with XDR-TB or pre-XDR-TB’s life when
combined with the person’s remaining salvage therapy options (which may not be
adequate on their own). It is already available on compassionate use in several
other countries — but officials in South Africa appear to be dragging their
feet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends
checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.